Atlas Essential America

How Atlas Essential America Insurance Works

First

You pay the deductible once per policy period, even for Dr. visits.

Then

Plan pays 75% of eligible expenses up to the policy maximum. You pay 25% of eligible expenses up to the policy maximum.

Overview

Atlas Essential America is a comprehensive coverage plan for non-U.S. citizens traveling outside their home country. You can obtain an instant quote and/or purchase online using this web site. The insurance coverage can start as early as today or any future date you specify. As soon as you make a purchase, you will receive a virtual id card in your email. Physical cards along with the policy will be mailed to you on the next business day. You should receive them in about five to seven business days within the United States.

What is covered and not covered?

The insurance company will generally pay for new medical conditions, injuries or accidents that may occur after the effective date of the policy. It does not cover any expenses related to pre-existing conditions, preventive check ups, immunizations or maternity.

U.S. Urgent care visit is $50 copay and not subject to deductible, if your deductible is $0, the $50 copay is waived. After which 25% co-insurance applies. If you visit the emergency room for a sickness (not for injury) for which you are not admitted into the hospital, there is $200 penalty per visit.

Prescription drugs are covered like any other eligible medical expenses as an inpatient; there is no coverage for outpatient drugs.

Emergency Dental Treatment to sound and natural teeth is covered in the case of an Accident under this insurance. For any practical dental coverage, consider a low cost plan from CAREINGTON that provides excellent coverage.

How do I use the insurance?

How much is covered?

First, you will have to pay your chosen deductible once per policy period (choices vary from $0 to $2,500) before the insurance company starts paying anything for the covered expenses, even for doctor visits. You will need to continue to pay all the money yourself until you have completely satisfied the deductible. The deductible is not just for hospitalization. There is no concept of copay, except for U.S. Urgent Care visits and visits to the emergency room for an illness that does not result in admission to the hospital.

After the deductible is met, the plan pays 75% up to the selected policy maximum, (choices ranging from $50,000 to $1,000,000, depending upon your age). You pay 25% up to the selected policy maximum. In other words, if you choose a plan with a $50,000 policy maximum, you will have to pay a maximum $12,500 out of your pocket towards the 25% coinsurance.

Example:

Lets assume that you have purchased a $50,000 policy maximum with a $250 deductible for 3 months.

Let's assume that the doctor charges you $150/visit and you need to visit several times.

The first time you visit the doctor, you will have to pay all of that $150 yourself. You still have $100 left towards the unsatisfied deductible.

On the second visit, the doctor charges $150/visit, you will have to pay $100 yourself. After that $100 is paid, then you have completely satisfied your deductible once per policy period. The remaining $50 is paid as follows, the plan will pay $37.50 which is the plan's 75% coinsurance. You will pay $12.50 which is your 25% coinsurance.

For any subsequent treatment (whether for the same condition or a different condition), you don't have to pay the deductible again.

After that, the insurance plan will continue to pay 75% for covered medical expenses, and you continue to pay 25% up to the selected policy maximum.

Let's assume that you were in an accident and are hospitalized for 2 days.

The hospital charges $12,000 per day for a total bill of $24,000. Assuming this is the first instance of your needing to use the insurance, you pay your $250 deductible, and the insurance company will pay 75% or in this case $17,812.50. You will pay 25% or for this case $5,937.50. plus your deductible, $250; the total amount you must pay from your pocket is $6,187.50.

Even if you extend your insurance, you don't have to pay the deductible again.

You visit an urgent care. You simply pay $50 copay and the rest is covered at 75% for eligible expenses, you would pay 25% of the co-insurance. Urgent care visit is not subject to deductible. (If you had selected a $0 deductible, then you would not pay a $50 copay.)

You go to an emergency room for a sickness. The hospital does some test and gives some treatment but does not admit you. In additional to your deductible and applicable coinsurance, you will have to pay an additional $200 penalty for that visit, because you were not admitted. However, if it were an injury or accident, you wouldn't have to pay a $200 penalty, even if you were not admitted.

DISCLAIMER: This is a high level description of the insurance plan meant to provide a quick overview. It may not describe all possible scenarios or coverages in all different cases. Please refer to the brochure and the certificate wording for complete details. Even though we have tried our best to accurately describe the plan, if there is any discrepancy between this description and the certificate wording, the certificate wording will prevail.